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JAUNDICE

Jaundice is not a disease. It is a symptom of liver disease. Nowadays liver problem is increasing day by day due to unhealthy life style. Thousand numbers of studies have proved that many people died for jaundice. So, we have to be careful about jaundice and so, at first we should know some basic ideas about liver.

What is liver?

The liver is a large organ that located in the upper right side of the abdomen and below the diaphragm and to right of the stomach. It is reddish brown in color. It has four sections and the gallbladder is located just under the liver. Gallbladder stores the bile which helps in digestion.

Functions of liver:

• Liver provides energy by storing it in the form of glucose which is the main source of fuel for body’s cell called glycogen.
•  Liver cleans our blood.
•  Regulate the balance of many hormones, body cholesterol, essential vitamins and minerals.
•  Liver produces bile that helps to eliminate toxic substances from the blood and helps to digest and absorb the food.

Symptoms:

•    Fatigue
•    Nausea
•    Vomiting
•    Jaundice

Now, we will discuss the matter of jaundice which is very serious problem and it can cause death.

 Damage to liver cells leads to increase bilirubin resulting jaundice. Jaundice is a common symptom to many disease of the liver. It is a yellowish pigmentation of conjunctiva skin and body tissues because of the accumulation of bile pigmentation in the blood. Hyperbilirubinemia (increased level of bilirubin in the blood) is a subsequently causes increased level of bilirubin in the extracellular fluid. Concentration of bilirubin in the blood is normally below 1.2 mg/dl. A concentration higher than 2.5 mg/dl leads to jaundice. A bilirubin level more than 5 mg/dl leads to jaundice in an infant.

Types of jaundice:

i)   Hepatocellular jaundice:-

This disruption occurs inside the liver due to the Gilbert’s syndrome or other liver damage.

ii)    Hemolytic jaundice:-

This disruption occurs when after 120 days of life RBC (Red Blood Cells) is broken that is called hemolysis and it leads to an increase production of bilirubin.

iii)  Obstructive jaundice:-

This disruption occurs when decrease the function of liver and it leads to obstruct the flow of bile to the intestine from the liver and remain in the blood stream. This is caused by condition like gallstones.

Symptoms:

• Yellow tinge to the skin.
• Yellowing of mucous membranes in mouth and nose.
• Sclera (whites of the eyes).
• Fatigue.
• Itchiness.
• Abdominal pain (when blocking of the bile duct).
• Vomiting.
• Urine dark in colour.
• Stools (faeces) can be pale in colour.
• Weight loss.

Complications of jaundice:

Some individuals do not suffer any long term after effects. They live a healthy life. But some others suffer from serious complications after effects and can cause death.

A few of the potential complications include-

• Electrolyte abnormalities (calcium, potassium, magnesium, sodium, chloride imbalance).
• Anemia.
• Infection.
• Chronic hepatitis.
• Kidney failure.
• Hepatic encephalopathy (brain dysfunction).
• Death.

Causes of jaundice:

After 120 days of life red blood cells are broken and release bilirubin from heame after a complex chemical reaction. The bilirubin is excreted in stools and urine along with bile. But when increase the destruction of the liver the result is obstruction to flow of bile from the liver and it accumulates in the blood can result in jaundice.

 Diagnosis of jaundice:

The yellowish skin and yellow eyes are the main clues for a doctor which he or she can use before confirming a diagnosis.

• A person may be asked about foreign travel or illegal drug use.
• Abdominal pain another clues for diagnosis jaundice.
• Urine can be tested for urobilinogen which is produced when bilirubin is broken down.
• Dark urine color is found.
• Blood test is used to check malaria or hepatitis.

Besides these, to look inside the body for diagnosis doctor may ask to test X-Ray. MRI or CT Scan, liver or bile duct using ultrasound.

Treatment of jaundice :

Treatment depends on the cause of underlying condition of jaundice and many complications related to it. Sometimes after diagnosis of jaundice treatment can be cured the patients and there are many who have not require of hospitalization.

• Rest is very important for the patients to prevent jaundice.
• There may be required of intravenous fluids, medicines for treatment.
• Blood transfusion may be needed.
• If drugs or any toxic substances that can damage the liver is the reason of jaundice. These must be discontinued.
• Diet is another important factor. So, patient should be careful about diet and avoid junk, oily foods and a dietitian can help in this case.

Preventive measures:

• Avoid heavy alcohol use.
• Avoid use of illegal drug or toxic substances.
• Avoid the practice of unprotected intercourse.
• Take medicines before travelling to high risk regions.
• Maintain a proper diet by avoiding junk and fatty foods.
• Always eat fresh fruits and vegetables.
• Maintain hygiene by washing your hands before eating and after using the washroom to stop the transmission of virus.
• Do not share needles.
• Take hepatitis A vaccine.

Dietary guidelines:

• Some dietary changes in your daily life can prevent jaundice and you can lead a good healthy life. So, you need to maintain some dietary guidelines when you formulating a healthy diet for a jaundice patient.
• High carbohydrate in the diet is essential for jaundice patient to provide enough energy.
• In nasogastric feeding , about 100 kcals are supplied and in severe 1600 – 2000 kcals are required for the energy.
• If patient suffers from nausea or vomiting, intravenous glucose water should be given frequently.When patient can take oral feeds intravenous feeding should be stopped.
• Besides these, patient can take fruits and vegetable juices such as lemon juice, carrot juice, cucumber juice which helps in maintaining the electrolyte balance.
• You can take 3 – 4 teaspoon of lemon juice with slight hot water in the every morning.
• Pomegranate juice is very effective for jaundice to prevent anemia.You can take it 1 glass in mid morning.
• You can take turmeric, beet for removing toxins from the blood. You can eat turmeric powder with curd and eat a pinch of raw turmeric and honey regularly. It is good for fighting against the infection.
• requirement of moderate protein is necessary to heal the damaged liver cells and regenerate the liver cells. So, we have to be careful about protein intake.With severe jaundice 40 gm protein and in mild jaundice 60 -80 gm of protein is required.
• You can take fat free milk like skimmed milk or double toned milk  in the form of sour curd.( homemade).
• If you want to take tea, you should intake liquor tea (without milk)
• All fatty foods should be restricted for at least 3 months. In severe 20 gm and in moderate 20 – 30 gm of fat are recommended.
• You should be avoided cream, butter, nuts, cheese, ice cream, sweets and fried foods.
• You may eat Marie biscuits, arrowroot thin, cream cracker biscuit. But all rich cookies should be avoided.
• You must avoid spices foods such as rich curry. You should eat bland diet without spices and masala. Boiled vegetables should be eaten for first 3 months such as bitter gourd, ladies finger. Boiled papaya should be eaten for clearing stools.
• Dal water or thin dhal can be given which is not spicy. For extra flavor you can add vegetables to it.
• In case of severe jaundice dhal, meat, egg should be omitted.
• In South Indian dishes, you may eat idly. It is safe for jaundice patient.
• For recovery 500 gm of vitamin C is needed.
• If there occurs lot of vomiting sodium, potassium may be lost. So, limes you can add. If there is no problem of swelling add salt 400 – 800 mg/day.
• You should keep in mind that small frequent meal is good for health. Heavy meal in one time should be avoided.